Side Effect: Cytokine Release Syndrome (CRS)

What is Cytokine Release Syndrome (CRS)?

• Cytokine release syndrome (CRS) is a systemic inflammatory response that can occur as a result of various stimuli, including cancer immunotherapy treatments.
• It is characterized by the overproduction of cytokines, which can cause a range of symptoms from mild flu-like symptoms to life-threatening complications.

What does Cytokine Release Syndrome (CRS) look like?

The symptoms of CRS can vary depending upon the severity of the condition, but may include:

• fever
• shaking
• fatigue
• weakness
• headache
• muscle pain
• nausea
• diarrhea

In more severe cases, patients may experience:

• low blood pressure
• low blood cell counts
• tachycardia
• trouble breathing
• changes in mental status
• liver or kidney injury

Who gets Cytokine Release Syndrome (CRS)?

• Patients with cancer who receive immunotherapy treatments, such as CAR T-cell therapy or bispecific T-cell engager (BiTE) antibodies, are at an increased risk for developing CRS.
• Risk factors for CRS include a high tumor burden, acute leukemia, aggressive lymphoma, and the specific CART or BiTE medication used.

How to prevent Cytokine Release Syndrome (CRS)

• Prevention of CRS involves careful patient selection, monitoring of vital signs, and close observation of patients for signs and symptoms of CRS.
• In some cases, the use of an anti-IL-6 receptor antibody, such as tocilizumab (Actemra®), has been shown to be effective in preventing and managing CRS in some patients.

How to treat Cytokine Release Syndrome (CRS)

The treatment of CRS involves early and quick supportive care measures.

• In low grade CRS, treatment measures include intravenous hydration, acetaminophen (Tylenol®), and use of antibiotics if there is also concern of a possible infection.
• In more severe cases of CRS, additional treatment measures that may be used include:
• Cytokine inhibitors: tocilizumab (Actemra®), siltuximab (Sylvant®)
• Corticosteroids: dexamethasone (Decadron®), methylprednisolone (Solu-Medrol®)
• Oxygen supplementation
• Vasopressors to increase blood pressure.
• Mechanical ventilation